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"Fat Day" is Imminent. What Are Your Patients Doing About It?

Based on a survey conducted by the largest cosmetic surgery provider in the U.K., 76% of British women feel "depressed" about their appearance in January, related to an average weight gain of 11 pounds during December. Inquiries about cosmetic procedures peak on the third Monday in January, dubbed "Fat Day" in the U.K. (more info here).

Most people will, of course, try various diet and exercise programs before resorting to cosmetic or bariatric surgery. And, in case you hadn't noticed, the annual media blitz is on, complete with nonstop TV commercials and infomercials, magazine covers and celebrity spokespersons touting the diet plan that supposedly helped them lose weight and regain their glam looks.

Below we summarize the features of the major commercial diets plus some new and/or fashionable diets that are less familiar but have gained recent notoriety through celebrity use or endorsement.

The Big 3

Janet Jackson, 45, for Nutrisystem

Nutrisystem is a prepackaged, caloric restriction diet. Food is shipped to the consumer, who provides fresh produce.

Support is through online community chat rooms and counselors and dietitians available by phone or online.

The Dukan Diet

French physician Dr. Pierre Dukan's diet became popular when it was rumored that Kate and Pippa Middleton (and their mum, Carol) used the diet to slim down for the Royal Wedding.
The Dukan method is a high-protein, low-fat, low-carb diet. It consists of four phases.

Phase 1, The Attack diet, starts with protein only.

Phase 2, The Cruise diet later alternates days of protein with days of protein and vegetables.

Phase 3, called the Consolidation diet, "gradually returns previously forbidden foods and allows for two 'celebration' meals per week".

The last, Phase 4, is a life-long Stabilization diet of using what you learned in the first 3 phases. There are also 3 "non-negotiable" requirements:

The British Dietary Association has blasted the Dukan Diet as one of the worst of the year, calling it “ineffective and without scientific basis.” Our own research confirmed that there is no scientific evidence to support Dr. Dukan's beliefs and recommendations. Le Journal des Femmes Sante surveyed diet followers and found that, despite rapidly losing weight initially, the vast majority regained all the weight they had lost within the next few years.

The Blood Type Diet

This diet, devised in the mid-1990s by American naturopathic physician Dr. Peter J D'Adamo, is outlined in his book Eat Right 4 Your Type. Celebrity proponents include Miranda Kerr, Demi Moore, Liz Hurley, Courtney Cox and Cheryl Cole.
The premise of this diet is that the kinds of foods you should eat (or avoid) is dependent upon your blood type. Exercise is tailored according to blood type as well.
Dr. D'Adamo divides dieters into 4 groups according to their blood type:

Type O: thrive on a carnivorous diet of lean red meats and benefit from rigorous exercise.

Type A: the first human cultivators, do well to avoid animal proteins and are at their best on a macrobiotic diet. Due to their naturally high-strung dispositions, they benefit from relaxing forms of exercise such as yoga and tai chi.

Type B: had a nomadic lifestyle. Due to this they are the most versatile of all blood groups and should adhere to a balanced diet and moderate group exercise.

Type AB: the rarest and youngest blood type, have benefits and intolerances from both A and B blood groups. They should follow a light exercise regime similar to type As.

Is there any merit to this theory? None whatsoever.
"I know of no plausible rationale behind the diet," says John Foreyt, PhD, a researcher at the Baylor College of Medicine in Houston.
Katherine Tallmadge, M.A., R.D., a spokesperson for the American Dietetic Association, goes on to say:

There's no scientific proof that eating and exercising according to your blood type will help you lose weight. If you follow the diet and do lose weight, it's probably because you're eating fewer calories, not because there's something magical going on with your blood type and the foods you're eating.

More recently, Dr. D'Adamo has re-invented his approach, now basing his recommendations on six "GenoTypes" (Hunter, Gatherer, Explorer, Teacher, Warrior, Nomad) rather than four blood types. As with the Blood Type Diet, there is no scientific rationale behind these beliefs and dietary recommendations.

Sunfare and The Fresh Diet

If you happen to live in Los Angeles or Phoenix, you can join the Sunfare diet just like celebrities Britney Spears and Garcelle Beauvais. Three prepared meals and two snacks are delivered fresh to your door each morning. Daily calories run about 1200 cal/day, and come as "signature," "vegetarian," or "family" menus.

The Signature diet is based on a low-carb approach, with 30% of calories coming from lean protein, 40% coming from low-glycemic-index carbs, and 30% coming from healthy fats.

Although it seems like a relatively easy and balanced way to lose weight, there are two main problems: its limited area of availability and the cost of the program. Per-day prices are $51 for three meals plus three snacks. This puts it out of the price range of most people.

The Fresh Dietis similar to Sunfare, but is available in more regions, including south and southwest Florida, Chicago, Indianapolis, the New York tri-state area, southern and northern California, San Francisco, Dallas, Boston, Washington DC, Baltimore, Virginia, Philadelphia and Houston. The price is also a little more reasonable than Sunfare, at $35/day for three meals plus two snacks.

What Role does Cleansing and Detox Play?

Bowel cleansing and detox have been touted by celebrities such as Gwyneth Paltrow, Blair Underwood, Ashton Kutcher and Demi Moore.
The program, designed by detox guru Dr. Alejandro Junger, consists of two liquid meals and one solid meal a day. The solid meal must be without processed foods, dairy and sugar.

"Detoxification" diets usually consist of a variable period of altered diet. This diet is high in fluids, high in fruits and vegetables, and eliminates alcohol, caffeine, and processed foods. Enemas to remove "toxins" from the colon are frequently included as well. Some diets also include special herbs or supplements which are supposed to enhance toxin removal.

“But the science behind the detox theory is deeply flawed", says Peter Pressman, MD, an internal medicine specialist at Cedars-Sinai Medical Center in Los Angeles. “The body already has multiple systems in place — including the liver, kidneys, and gastrointestinal tract — that do a perfectly good job of eliminating toxins from the body within hours of consumption.”
Many individuals will have temporary decreases in weight due to fluid loss.

Like Sunfare, it is only available in the Los Angeles area. It is a 1,200-calorie liquid diet consisting of juices that are produced on a hydraulic press. The company claims that this process extracts the finest produce straight from the pulp, minimizing oxidation and releasing vitamins, minerals, and enzymes into each juice that are impossible to produce with a normal juicer.

The juice is 100% raw and unpasteurized, giving it only a three-day shelf life. Six juice servings cost $70/day!

So there you have it - the diets that many of your patients are learning about from pop culture sources and aggressive marketing campaigns. What are you going to recommend to them?

In Part II of our story, we'll cover the activity, monitoring and accountability aspects of the diet and exercise equation. The old bathroom scale, tape measure and exercise log are "out," replaced by a plethora of smartphone apps, Bluetooth- and Wi-Fi-enabled monitoring devices, and diet and workout buddy social networks on Twitter.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

This survey is a poll of those who choose to participate and are, therefore, not valid statistical samples, but rather a snapshot of what your colleagues are thinking.

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